Deb Dana Sept 19

1 2019 DDP International Conference www.DDPNetwork.org 9 SEPT 2019

Traumatic Stress Research Consortium in the Kinsey Institute at Indiana University Engaging the Rhythm of Regulation A Polyvagal Theory Guide Directed by Stephen Porges, PhD to Safety and Connection and coordinated by Deb Dana, LCSW

The Consortium will research the experiences of trauma survivors and the clinicians who work with them, and the disruptive impact of trauma on the autonomic nervous Deb Dana, LCSW system, with the goal of identifying improved treatment debdanalcsw.com options. rhythmofregulation.com If you are interested in joining the Traumatic Stress Research DDP International Conference Consortium as a participating clinician and becoming a part September 9, 2019 of this important research project, please email:

[email protected]

Polyvagal Theory

The science of connection… Central Nervous System

The science of feeling safe enough to fall in love with life and take the risks of living…

Brain Spinal Cord

copyright Deb Dana, LCSW 2019 copyright Deb Dana, LCSW 2019 2 2019 DDP International Conference www.DDPNetwork.org 9 SEPT 2019

Autonomic Nervous System

Sympathetic Nervous System Parasympathetic Nervous System

Wikipedia

Autonomic Roots Autonomic Nervous System

Bi-directional Communication: Darwin recognized the importance of the brain to body and body to brain Sympathetic Nervous System Parasympathetic Nervous System pathways.

One way communication: J. N. Langley focused on the efferent (brain to body) pathways and minimized afferent (body to brain) pathways. Ventral Vagus Dorsal Vagus

copyright Deb Dana, LCSW 2019 copyright Deb Dana, LCSW 2019 3 2019 DDP International Conference www.DDPNetwork.org 9 SEPT 2019

The Birth of Polyvagal Theory Parasympathetic Nervous System

Ventral Vagus

The Vagal Paradox: Stephen Porges brought us an understanding Sympathetic Nervous System of the autonomic nervous system not as a balance system but as a predictable hierarchy.

Parasympathetic Nervous System Dorsal Vagus

A Polyvagal Perspective

“The great thing then, in all education, is to make our nervous system our ally as opposed to our enemy.” The “drive to survive” The “longing to connect” William James (1914, Habit)

The autonomic nervous system is the foundation for our lived Polyvagal Theory gives us a map to bring the autonomic experience. nervous system into the process of therapeutic change. engagement mobilization disconnection

copyright Deb Dana, LCSW 2019 copyright Deb Dana, LCSW 2019 4 2019 DDP International Conference www.DDPNetwork.org 9 SEPT 2019

Understanding the science reduces the shame. An autonomic nervous system that has been shaped by trauma is a highly tuned surveillance system! Polyvagal Theory helps us understand that behaviors are autonomic actions in service of survival - adaptive survival responses engrained in a survival story that is entered into Autonomic state shifts in response to the challenges of automatically. everyday life are a normal experience. For many people, the moves are slight and, even in the moments of large The autonomic nervous system shapes experiences of safety state changes, there is enough resilience to return to a and impacts ability for connection. regulated state.

If unresolved, early adaptive survival responses become For others movement along the continuum of autonomic habitual autonomic response patterns. response is much more extreme and impacts moment-to- moment capacity for regulation and relationship. Reducing shame makes room for curiosity and compassion.

The autonomic nervous system is shaped and regulated through interactions with others. Clients come to therapy with a compromised ability to regulate their states of activation. The autonomic nervous system SENDS and SEARCHES FOR cues of safety or danger The ability to successfully adapt to the changing environment, to respond and recover, relies on the autonomic nervous The cues sent from one system to another either: system. co-regulate and create new possibilities The ability to recognize and regulate states of autonomic activation is fundamental to the success of the therapy increase reactivity and reinforce survival responses process.

copyright Deb Dana, LCSW 2019 copyright Deb Dana, LCSW 2019 5 2019 DDP International Conference www.DDPNetwork.org 9 SEPT 2019

Polyvagal Theory is a hope-filled theory…

Emergent Properties Early, repeated interactions tone the autonomic nervous system and create an autonomic proﬁle.

Ongoing experiences continue to shape the autonomic nervous system. From a state of protection, (mobilization or disconnection) survival is the only goal. Adaptive survival responses close Re-patterning the autonomic nervous system is possible. the system to connection and to change.

A regulated nervous system is a resilient system. From a state of connection, (social engagement) health,

growth, and restoration are possible. Polyvagal Theory offers a roadmap to work with autonomic activation and build regulation and resilience.

The Autonomic Impact of Trauma

Compromised ability to regulate states of activation Co-regulation is often unavailable, • I’m often triggered but I can’t seem to regulate either by myself or with unpredictable, and unsafe. others. • I keep trying to be ok on my own - to not need anyone. • I’m desperate for connection to stay out of collapse. Self-regulation may be inadequate and unsuccessful. Habitual response patterns • I have to be ‘big’ to be safe. • Being seen is dangerous so I try to be invisible. Opportunities to build autonomic circuits • I feel stuck and fighting doesn’t help. I feel hopeless and I disappear. of connection are interrupted. Familiar stories brought to life by physiological state Adaptive survival responses override • Feeling good is dangerous. • My wants and needs are the problem so I shut them off quickly. social engagement. • My lack of predictable connections remind me I am a misfit, I don’t belong, I don’t matter. Patterns of protection replace patterns of connection.

copyright Deb Dana, LCSW 2019 copyright Deb Dana, LCSW 2019 6 2019 DDP International Conference www.DDPNetwork.org 9 SEPT 2019

“The trauma response is not a cortical deficit in Benefits of Autonomic Flexibility understanding, it is difficulty with perception and regulation that comes from the activity of deep brain structures and Reduced inflammation, regulation of pro-inflammatory the autonomic nervous system.” (van der Kolk) cytokines (Andersson &Tracy, 2012)

Control of immune response (Rosas-Ballina et al., 2011) “Trauma is a chronic disruption of connectedness.” Emotional regulation (Park & Thayer, 2014; Surland, et al., (Stephen Porges) 2016; McCraty & Zayas, 2014)

Ability to inhibit distractions (Park, Vasey, Bavel, & Thayer, Trauma stories are carried in 2014) states of autonomic dysregulation. Stress resilience (Pereira, Campos, & Sousa, 2017)

Risks Connected to Autonomic Rigidity

Vigilance for angry faces (Park & Thayer, 2014) Subjective wellbeing (Geisler, Vennewald, Kubiak, & Distraction from tasks to potential threats (Park, Vasey, Weber, 2010) Bavel, & Thayer, 2014) Increased capacity for friendship and connection (Kok & Inability to discern trivial from important cues (Park, Vasey, Fredrickson, 2010) Bavel, & Thayer, 2014) Social support seeking, Perceptions of social acceptance, Heightened “startle” response (Park &Thayer, 2014) social connectedness (Kok et al., 2013)

Hypoactive pre-frontal regulation (Park & Thayer, 2014) Compassion (Stellar, Cohen, Oveis, & Keltner, 2015)

copyright Deb Dana, LCSW 2019 copyright Deb Dana, LCSW 2019 7 2019 DDP International Conference www.DDPNetwork.org 9 SEPT 2019

Depression (Sgoifo et al, 2015) Three Autonomic Nervous System Needs for Safety Anxiety (Alvares et al., 2013)

Social isolation/loneliness (Grippo, Lamb, Carter, & Porges, 2007)

Impaired immune functioning, Inﬂammatory diseases 1. Context (Kenney & Ganta, 2014) 2. Choice

Digestive problems (Mazur, Furgala, Jabłoński, Mach, & 3. Connection Thor, 2012)

Respiratory problems (Gerbarg & Brown, 2016)

Chronic fatigue (Cauwenbergh et al., 2014) copyright Deb Dana, LCSW 2019 copyright Deb Dana, LCSW 2019

The Three Organizing Principles Neuroception of Polyvagal Theory Detection without Awareness

1. Neuroception - detection without awareness Neuroception describes the way the autonomic nervous system takes in information without involving the thinking 2. Hierarchy - three predictable pathways of response parts of the brain. Ventral Vagal Neuroception responds to cues of safety and danger: Sympathetic Nervous System • inside the body Dorsal Vagal • outside in the environment 3. Co-regulation - a biological imperative • between people

copyright Deb Dana, LCSW 2019 copyright Deb Dana, LCSW 2019 sulcus of fold the lateral hidden deepinthe Insula living. daily of our a story that shapes the creation drives neuroception of experience the wordless as begins what beings, making meaning- are humans Since 8 PAG Story Story Temporal Lobe Temporal 2019 DDPInternationalConferencewww.DDPNetwork.org

copyright DebDana,LCSW2019 copyright DebDana,LCSW2019 Autonomic State experience. to effectively necessary the energy bring state will the manage the autonomic and for the situation is appropriate …neuroception • • • hand movements with the query “is this person safe and safe and “is this person the query with movements hand intention faces, voices, to familiar cortex responds The temporal and movement evaluate the amygdala with communicate of Areas the involved in interoception. interoception. in involved Insula of pain). detection blocking of (the process anti-nociception in It involved is also behaviors. immobilizing and escape, confrontational, system to regulate nervous the sympathetic and vagus) system (dorsal nervous part of the parasympathetic the oldest with communicates PAG grey) (periaqueductal trustworthy?” When there is a neuroceptive match… is a neuroceptive there When Possible Possible of Anatomy Neuroception brings visceral feedback into cognitive awareness and is and awareness cognitive into feedback visceral brings temporal cortex temporal

- an ancient midbrain structure that midbrain - ancient an where “feature detectors” that detectors” “feature where copyright DebDana,LCSW2019 copyright DebDana,LCSW2019 9 SEPT2019 9 2019 DDP International Conference www.DDPNetwork.org 9 SEPT 2019

With a neuroceptive mismatch… Human Social Genomics and Neuroception

There is an inability to calm defense systems in safe Neuroception of danger activates threat related gene environments and the autonomic nervous system activates a expression. habitual protective response pattern. (hypervigilant - alarmed) “…increasing evidence that changes in the expression of literally hundreds of genes can occur as a function of the OR physical and social environments we inhabit. Moreover, it appears as though these effects are often more strongly There is an inability to activate defense systems in risk tied to peoples’ subjective experience of their surrounding environments. Neuroception does not signal danger when social environment than to objective features of those there is actual danger and the autonomic response is environments.” (Cole) inadequate to manage the situation. (risk-taking or dulled, https://www.youtube.com/watch?v=C62IDmGKZzg unaware)

Active and Passive Pathways

Passive Pathways: Neuroception exerts a powerful influence over our Neuroception is monitoring in, out and between (body, physiology. environment, relationships)

Cells are in a continual state of regeneration. Active Pathways: actions to consciously inﬂuence autonomic state, therapy “…our physiological state on any given day can influence models, processes, procedures our molecular make-up for weeks and months into the future.” (Slavich and Cole)

Regulation of passive pathways is necessary to support work with active pathways.

copyright Deb Dana, LCSW 2019 copyright Deb Dana, LCSW 2019 10 2019 DDP International Conference www.DDPNetwork.org 9 SEPT 2019

Features of Safety and Danger Being safer does not necessarily make us feel safer. The clinical question: In this moment do you see me (does your neuroception sense me) as a restorative resource or as Many of our social systems are focused on the features of a threat? danger and yet we have a profound sensitivity to features of safety and exposure to these can foster resilience. (Porges)

What are the cues of safety? Cues of danger? It is not just the removal/absence of cues of danger but also the active experiencing of cues of safety that our autonomic nervous At this moment in and around your body? system needs. At this moment in your environment? At this moment in your connection with others? We need to attend to the BOTH/AND of danger and safety. If we only pay attention to one and not the other our clients cannot fully experience wellbeing. A regulated system depends on

Hierarchy Three distinct pathways each working “in service of survival”.

parasympathetic parasympathetic dorsal vagal sympathetic ventral vagal 500 million years ago 400 million years ago 200 million years ago

immobilized mobilized safe and social A healing environment is a safe environment. disconnected fight and flight connected

Create a healing environment by listening to your ANS.

copyright Deb Dana, LCSW 2019 copyright Deb Dana, LCSW 2019 11 2019 DDP International Conference www.DDPNetwork.org 9 SEPT 2019

The Parasympathetic Branch SAFE — System of Safety and Connection Parasympathetic Ventral Vagal The Vagus Nerve “new” vagus Health, Growth, and Restoration the “wanderer” Individual and interactive regulation

From the brain stem at the base of DANGER — System of Mobilization Sympathetic the head (medulla), the vagus Adaptive Protection through action Nervous System travels down through the lungs, Aggression or active escape heart, diaphragm, and stomach… and upward connecting with nerves in the neck, throat, eyes, and ears… LIFE-THREAT — System of Immobilization Parasympathetic Wellcome Library London Dorsal Vagal Adaptive Protection through “disappearing” “old” vagus …to form the “face-heart” connection Biological conservation of energy and resources

The Vagus

10th Cranial Nerve

Longest of the twelve cranial nerves

Communicates bi-directionally between the body and the brain

Mixed nerve - 80% sensory (afferent) and 20% motor (efferent)

The two extremes of response - oldest immobilization and newest social connection

Myelin - an insulating sheath around nerve fibers (like the protective outside coating on an electrical wire) Ventral Vagus (supradiaphragmatic) safe and engaged creates healthy homeostasis connect, communicate Myelination - the process of wrapping the axon with myelin resulting in more efficient, quicker transmission of nerve divided at the diaphragm impulses Dorsal Vagus (subdiaphragmatic) The ventral vagus is primarily myelinated while the dorsal daily function: healthy survival response: move vagus is primarily not. regulation of the digestive out of awareness, out of system connection, into collapse The ventral vagus myelinates during the last trimester (30 weeks on) and continues over the first year of life.

The HPA Axis triggers the release of cortisol and adrenaline The Sympathetic Nervous System FIGHT OR FLIGHT

Exits the middle part of the spinal cord (thoracic and lumbar)

Inﬂuences breathing cycles, heart rhythms, blood ﬂow, blood pressure

Supports regulation of body temperature

Primes for action

By Anatomography (https://creativecommons.org/licenses/by-sa/2.1/jp/deed.en) Mobilizes for ﬁght and ﬂight via Wikimedia Commons

copyright Deb Dana, LCSW 2019 copyright Deb Dana, LCSW 2019 13 2019 DDP International Conference www.DDPNetwork.org 9 SEPT 2019

Nucleus Ambiguus, Ventral Vagus “social vagus” “smart vagus”

Safe, Motion, Emotion, Communication From Safety to Survival

What would it feel like To be safe and warm Arms strong but gentle Snuggled close Joined by tears and laughter Free to share, to stay, to leave… copyright Deb Dana, LCSW 2019

Newest Evolutionary Circuit - Ventral Vagal The Compassion Nerve Safely Embodied Keltner’s research People with high vagus nerve activity: • Co-regulation, self-regulation • respond to stress with calm and resilience • Primarily myelinated (myelinates during the last trimester • build networks and over the first year of life) • break up conflicts • Healthy homeostasis • are more cooperative • Regulated heart rate, full, easy breath • manage bereavement better • Take in the faces of friends. • Tune into conversations and tune out distracting noises Activation of the vagus is associated with: • Attention is toward connection (self and others) • feelings of care taking • Acknowledge distress and explore options • ethical intuition that humans from different social groups (even • Reach out for, and offer support adversarial ones) share a common humanity • feeling emotions that promote altruism - compassion, gratitude,

Resourced and resourceful copyright Deb Dana, LCSW 2019 love, and happiness copyright Deb Dana, LCSW 2019 14 2019 DDP International Conference www.DDPNetwork.org 9 SEPT 2019

Self Compassion Moving out of Safety into a Mobilized Self-Compassion: Kristin Neff’s research - using the power Sympathetic Nervous System of the ventral vagus to connect inside with kindness

1. This is a moment of suffering (my nervous system is in a Evolutionarily we are not safe moment of dysregulation) when we are separated from the group. 2. Suffering is a common human experience (dysregulation Moving out of safety on an happens regularly to every human being) autonomic level brings a sense of being cut off from others. 3. May I be kind to myself (may I bring a bit of ventral vagal Fear is whispering to me energy in this moment) And I feel the power of its message 4. Make a kind statement to yourself (speak from my ventral Move, take action, escape No one can be trusted vagal state) copyright Deb Dana, LCSW 2019 copyright Deb Dana, LCSW 2019 No place is safe…

The Sympathetic Response Protection Through Movement! In the beginning…the Dorsal Vagus

• Fight and ﬂight - movement is incompatible with shut down Oldest pathway of response Immobilized with fear • Feel the rush of adrenaline that makes it hard to sit still Immobilization as an adaptive survival response • Scan the environment looking for danger Neuroception of life-threat • Narrowed focus • Listen for sounds of danger and don’t hear sounds of friendly voices

• Sense of separation “One feels as if one were lying bound • Misread cues - neutral is experienced as dangerous hand and foot at the bottom of a deep Sacriﬁce social engagement for survival! dark well, utterly helpless.” Van Gogh

copyright Deb Dana, LCSW 2019 copyright Deb Dana, LCSW 2019 15 2019 DDP International Conference www.DDPNetwork.org 9 SEPT 2019

Earliest Evolutionary Circuit - Dorsal Vagal The Vagal Brake: A System of Regulation through Relaxation and Re-engagement Scared to death • Shut down, collapsed The vagal brake: • Dissociation (foggy - not here) allows us to rapidly engage and disengage • Disconnection • Numb to quickly energize and calm • Breath almost imperceptible brings a sense of ease to transitions • Decreased heart rate

• Despair • Escape into not knowing, not feeling, almost a sense of not When the opportunity to exercise the vagal brake is a being missing experience, the ability to move between states is • Safety and hope feel unreachable impacted. The path of last resort

• Find an image that brings to life your sense of regulating the increase and decrease of energy in your ventral vagal pathways

• An image that gives you the feeling of controlling the dimensions of something (brakes, door, bridge, faucet)

• You are an active operator of your vagal brake shaping the rise and fall of energy to meet a challenge

• Bring it to life through your senses — see it, hear it, feel yourself adjusting it, and feel your energy moving in synchrony with the changing image

copyright Deb Dana, LCSW 2019 Download for free at http://cnx.org/contents/[email protected]. 16 2019 DDP International Conference www.DDPNetwork.org 9 SEPT 2019

The Art of Savoring

• Play with the experience of intentionally exercising your vagal brake. Attend to a VV moment Bring it alive • Imagine releasing the brake to meet a speciﬁc challenge Savor it for 20-30 seconds — a micro-moment of and re-engaging the brake when the challenge is over. appreciation Share it Experiment with a variety of challenges. Notice how your • Amplifying? vagal brake is able to release and allow your energy to Dampening? rise to the challenge while maintaining the ventral vagal state of safety and then re-engage with a return to your ventral vagal setpoint Savor the State Savor the Experience

Savor the State Tone the System Savor the Experience Tone the System Bring attention to a moment of VV regulation and bring the Bring attention to a moment of VV regulation and bring the physical sense of the state alive. physical sense of the state alive. Sense the moment in your body and then invite in the Stay present to the physical sense of this state (e.g., images, feelings, and thoughts that accompany the breath, heartbeat, warmth, energy moving, a sense of moment. internal space). Actively receive the fullness of the experience (sight, Imagine your vagal brake working effortlessly, smoothly, sound, emotion, belief, body). Invite the physiology and keeping the flow of ventral vagal energy moving. story to move together.

Savor the VV experience for 20-30 seconds. (A micro- Savor the VV experience for 20-30 seconds. (A micro- moment of appreciation) moment of appreciation)

Add reciprocity to the experience. Add reciprocity to the experience. copyright Deb Dana, LCSW 2019 copyright Deb Dana, LCSW 2019 17 2019 DDP International Conference www.DDPNetwork.org 9 SEPT 2019

Hierarchy in Action Autonomic Loops

Ventral Vagal Sympathetic Ventral Vagal vagal brake relaxes and re-engages

Sympathetic

vagal brake released HPA axis engaged Dorsal Vagal Sympathetic

Dorsal Vagal copyright Deb Dana, LCSW 2019 copyright Deb Dana, LCSW 2019

Systems in Balance Without a Ventral Vagal Anchor

Without the ability to be anchored in ventral, we are pulled Just as both the left and right hemisphere bring balance to our mind-brain experience, all three parts of our ANS into conservation and activation as we try to find regulation. cooperate to bring us an embodied sense of wellbeing.

With the ventral vagus overseeing the system, the An autonomic system that is missing the regulating sympathetic and dorsal vagal branches add their regulating, influence of the ventral vagus… non-reactive actions and a sense of homeostasis is

achieved. brings health challenges The ability to return the ANS to homeostasis creates distress in relationships is a measure of resilience. shapes a daily experience of suffering

copyright Deb Dana, LCSW 2019 copyright Deb Dana, LCSW 2019 18 2019 DDP International Conference www.DDPNetwork.org 9 SEPT 2019

Finding Ventral Vagal Anchors

1. Identify the predictable who, what, where, and when of your ventral vagal system.

2. Create a practice of turning to these when looking for a resource. Life on the Ladder 3. Use them to deepen a ventral vagal state.

The Autonomic Ladder

Ventral Vagal Neuroception of safety With a new understanding of the autonomic nervous system, social how do we begin to turn toward this energy and information in engaged connected a compassionate way?

Safely enter into autonomic awareness Neuroception of danger Sympathetic mobilized Bring perception to neuroception action taking fight and flight Orient on an autonomic map

Dorsal Vagal Neuroception of life-threat immobilized shut down copyright Deb Dana, LCSW 2019 collapsed copyright Deb Dana, LCSW 2019 19 2019 DDP International Conference www.DDPNetwork.org 9 SEPT 2019

The Personal Profile Map - Where Am I?

Ventral Vagal

Safe

Connected I am… Identify Interrupt The world is…

Sympathetic

State Regulating Resource Mobilized Fight - Flight I am… The world is…

Shared Language Shared Understanding Dorsal Vagal

Immobilized I am… The world is… Collapsed

copyright Deb Dana, LCSW 2019 The Personal Proﬁle Map The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation (Norton, 2018)

The Essential Notice and Name Skill

ﬂow, connected, warm, open-hearted, curious, engaged, capable Ventral Vagal organized, passionate, at ease Engage with a state not just be engaged by it… FLOW Safe I am…OK The world is…welcoming, ﬁlled with opportunity 1. Notice where you are on the autonomic map. Connected

2. Name the state. out of control, too much, confusing, overwhelming, angry Sympathetic confrontational, ready to run CHAOS Mobilized I am…crazy, toxic 3. Turn toward your experience. The world is…unfriendly, scary, exploding Fight - Flight 4. Bring curiosity.

dark foggy, fuzzy, silent, out of focus, cold 5. Listen for a moment to the story of your state. Dorsal Vagal numb, hopeless, helpless, shut down, disconnected DARKNESS

I am…unloveable, invisible, lost and alone Immobilized The world is…cold, empty, uninhabitable Collapsed

copyright Deb Dana, LCSW 2019 copyright Deb Dana, LCSW 2019 20 2019 DDP International Conference www.DDPNetwork.org 9 SEPT 2019

Hearing the Story of Three States Three Circuits, Five States Ventral Vagal • Choose an experience to investigate. A moment of slight Safe and Social irritation is often a good starting point. Play • Anchor in your ventral vagal energy. Sympathetic From your anchor in ventral, move into connection with your • Intimacy, Stillness dorsal and sympathetic states. Begin by listening to the Sympathetic Mobilized state you are most familiar with and then the other. What is Danger the story of the experience from each of these states?

• End with listening to the story from your ventral vagal state. Dorsal Vagal Review the three stories. How does each state interpret the • Dorsal Vagal experience? Immobilized Life-Threat copyright Deb Dana, LCSW 2019 copyright Deb Dana, LCSW 2019

Parasympathetic Nervous System Ventral Vagus The State of Play Play is a neural exercise. Play Polyvagal play is face to face, reciprocal, and synchronous.

Ventral and sympathetic are “holding hands”. Sympathetic Nervous System If ventral vagal and sympathetic lose contact, the excitement of play turns into the scariness of aggression.

For many clients rather than a ventral vagal inspired happy anticipation, opportunities for play bring the dysregulating Parasympathetic Nervous System Dorsal Vagus energies of survival response.

When you think about play what is your autonomic response? copyright Deb Dana, LCSW 2019 copyright Deb Dana, LCSW 2019 21 2019 DDP International Conference www.DDPNetwork.org 9 SEPT 2019

Parasympathetic Nervous System Ventral Vagus Safely Still

The ancient and new vagal circuits working together to

Stillness immobilize without fear. Sympathetic Nervous System Becoming still without stimulating shut down is challenging.

Consider the many ways we are expected to move from action to quiet.

Parasympathetic Nervous System Dorsal Vagus

Autonomic State and the Nuance of Tone Creating Continuums

In the beginning it is important to recognize the three Each state has a range of experiences in it - a continuum discrete states. that can be identified.

With the ability to identify ventral, sympathetic, and dorsal Use continuums to explore the “flavors” of each state. we then move to feeling the nuance of each state and the combinations of states that creates an overall tone of an 1. Name each end of the continuum experience. 2. Then begin to move in small increments Each state has a range of experiences in it - a continuum between the ends. that can be identiﬁed. 3. This can be done on paper or in space. The many state changes during a period of time come together to bring a ﬂavor of autonomic experience.

copyright Deb Dana, LCSW 2019 copyright Deb Dana, LCSW 2019 22 2019 DDP International Conference www.DDPNetwork.org 9 SEPT 2019

The Third Organizing Principle: Co-Regulation

Connection is a biological imperative. We are wired for connection. Loneliness and perceived loneliness are physiological and We are waiting for connection. psychological risk factors.

Social support does not always correspond with social connection.

Through reciprocal regulation of autonomic states we feel safe enough to move into connection and create trusting relationships.

Co-regulation is a necessary prerequisite for self- “…without the experience of an organizing other…the regulation. If we miss co-regulating opportunities in nervous system is stunned.” (Sebern Fisher) childhood, we feel the loss in our adult relationships. In our work, we are responsible for being the regulated and regulating other. If we are dysregulated, there will be a rupture in attunement and our client’s autonomic response will be an automatic move out of connection into protection.

Our clients’ autonomic nervous systems have often been What message is your shaped away from connection toward protection. autonomic nervous system sending?

copyright Deb Dana, LCSW 2019 copyright Deb Dana, LCSW 2019 23 2019 DDP International Conference www.DDPNetwork.org 9 SEPT 2019

The Social Engagement System

Formed through the evolutionary integration of Cranial Nerves V (trigeminal),VII (facial), IX (glossopharyngeal), X (vagus), XI (spinal accessory)

Controls: Facial expression (emotional expression) Eyelids (social gaze) Middle ear (hear human voice) Mastication (ingestion, sucking) Larynx, pharynx (vocalizing, swallowing, breathing) Head turn and tilt (social gesture, orienting)

Five cranial nerves joined in the search for connection through our… Moving in and out of eye contact is a regulating action. We use the eyes (orbicularis oculi) to sense safety and signal safety.

eyes

ears

voice

face and head movements “…the zygomatic major can be willed into action, but only the sweet emotions of the soul force the orbicularis oculi to

copyright Deb Dana, LCSW 2019 contract.” Duchenne Gray's Anatomy of the Human Body 1918 Used with permission: copyright Kate White ppncenter.com 24 2019 DDP International Conference www.DDPNetwork.org 9 SEPT 2019

The Power of Prosody Experimenting with the Power of Eyes • The music of the voice Stare (strong, focused, a hint of a glare, you might feel your • Patterns of rhythm and sound eyes moving outward from their sockets) • Frequency Look (neutral, less strongly focused, you might feel you • Duration eyes settling back into their sockets) • Intensity Gaze (soft, warm, you can feel your eyes deeply resting in • Reveals the underlying intent their sockets)

Both as a sender and a receiver: Intonation before Information Track your ANS response to each. What is your neuroception?

Neuroception and Vocal Bursts Reciprocity - Rupture - Repair When you don’t know what to say…use a vocal burst.

“non-language sounds” we use to communicate Autonomic intimacy ahhh, mmmm, ohhhh, humph Biological rudeness - violating neural expectations understood across cultures understood across species Using the power of the Social Engagement System to bring understood with a high degree of accuracy safety and connection

Navigating the autonomic ladder…(an adult experience of Tronick’s Still Face Experiment) What is the autonomic message you are sending? What does your client’s neuroception tell them?

copyright Deb Dana, LCSW 2019 copyright Deb Dana, LCSW 2019 25 2019 DDP International Conference www.DDPNetwork.org 9 SEPT 2019

Reshaping the System Polyvagal Theory Guided Therapy

The autonomic nervous system is always being shaped - either re-patterning or deepening an existing pattern. Story

Clients’ autonomic maps change as they “tune and tone”.

With new maps, clients begin to look for other people whose rhythms are similar.

Breath, movement, proximity, touch Autonomic State Autonomic

Following the Four R’s

Recognize the autonomic state “Earth will be safe Respect the adaptive survival response when we feel in us enough safety.” Thich Nhat Hanh Regulate/co-regulate into a Ventral Vagal state

Re-story

Regulate and Reshape

From a place of dorsal vagal influence, choose an action The autonomic nervous system is either in an adaptive survival that begins to bring a gentle return of energy. response or in a state of safety and readiness for connection.

From a place of sympathetic activation, choose an action In either sympathetic or dorsal survival, the goal is to bring enough ventral back to come into the safety of connection. to safely discharge energy and move back into a state of ventral vagal regulation. Until there is enough ventral regulating the system, change can’t happen. Sympathetic and dorsal states are incompatible with safety and safety is a requirement for healing. From a place of ventral vagal regulation, choose an action to maintain or deepen the state.

The Guiding Question: The Guiding Question What does my nervous system need in this moment? What does my client’s nervous system need in this moment? Learn to track your movements up and down the ladder. Be curious about the state. Navigate moments of dysregulation.

Shape your autonomic nervous system towards safety What are the cues of danger and safety? and connection. Find the “just right” act of attunement and degree of neural challenge. Practice Polyvagal-informed Self-Care. Practice ongoing tracking. There must be (at least) one ventral vagal system in the Offer ventral vagal anchoring. room…and it must be ours!

copyright Deb Dana, LCSW 2019 copyright Deb Dana, LCSW 2019 27 2019 DDP International Conference www.DDPNetwork.org 9 SEPT 2019

Benevolence Reshaping practices remind the autonomic nervous system that it has an inherent knowing about how to flexibly navigate the autonomic hierarchy.

A flexible system is a resilient system… …and a resilient system carries stories of possibility.

The active, ongoing, use of ventral vagal energy in service of healing… copyright Deb Dana, LCSW 2019